The increasing number of older patients with renal disease

Trainees in nephrology should enhance their skills in geriatrics

“Are my kidneys going to wear out before the rest of me?” is a valid question for older patients with hypertension and a raised serum creatinine concentration. The extent of the problem is illustrated by a study in an inner London primary healthcare setting.1 In the age group 50-75 years, the prevalence of renal impairment (serum creatinine higher than 120 μmol/l) was 6.1% in patients known to have hypertension, 12.6% in those known to have diabetes, and 16.9% in those with both.1 Many of these patients will progress to end stage renal failure. Of the one million patients who need chronic dialysis worldwide, more than half are over 65 years, as are approximately 10% of patients waiting for cadaveric transplants. www.uktransplant.org.uk The renal registry report for the United Kingdom for 2002 indicates the acceptance rate for dialysis for patients over 65 is approaching 300 patients per 1 000 000 population, compared with 72 per 1 000 000 population in those aged 18-64 years.2

Many of these patients will progress to end stage renal failure. Of the one million patients who need chronic dialysis worldwide, more than half are over 65 years, as are approximately 10% of patients waiting for cadaveric transplants.2 The renal …